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It's time to change attitudes on mental health

With statistics suggesting that one in four South Africans will experience a mental disorder in their lifetime, it’s likely that one day you or a family member, friend or colleague will experience a mental health problem.

According to the World Health Organisation, depression will be the second most disabling health condition in the world by 2020. In total, mental disorders will account for 15% of the global burden of disease.

Data from the Council for Medical Schemes shows that bipolar mood disorder grew faster than any other chronic condition from 2006 to 2011, increasing by a staggering 228.6%.

Mental illness contributes to high levels of absenteeism, poor work quality and impaired productivity which, in turn, impacts directly on company bottomlines.
The social cost of mental illness is also severe, with mental health issues fueling a vicious cycle of outcomes that include rising substance abuse, crime, violence and marital and family breakdowns.

Challenges ahead

Despite the negative impact of mental illnesses, the provision of mental health services lags far behind other health services in almost every aspect.

While it’s time for serious change, Dr Unati Nemuhuyuni, head of public-private partnerships at Metropolitan Health, points out that we face some formidable obstacles in the form of ignorance, stigma and insufficient resources.

Minister of Health, Dr Aaron Motsoaledi, said that it is time to move away from mental health being treated as the “Cinderella of the health system”. However, the Department of Health currently spends only 4% of its budget (about R9.3-billion) on mental health illnesses.

Other diseases associated with far higher mortality rates, such as HIV and Aids, demand a greater slice of a constrainted health budget. Mental health issues have to be tackled within a reality of severely limited resources and a heavy triple burden of infectious diseases, non-communicable diseases (NCDs) and injuries.

Some areas are more exposed than others. Cash-strapped rural South Africans tend to be more vulnerable to the rise and fall of the economic cycle. This generates high levels of stress in an environment where access to counseling and other mental health services is limited.

The results include high alcohol and tobacco consumption as well as depression. This makes it difficult for rural dwellers to break out of the downward spiral of poverty-ill health-low productivity.

Nemuhuyuni points out that mental health issues are still poorly understood and often surrounded by prejudice, ignorance and fear. Many South Africans would “rather die” than admit they suffer from a mental illness.

According to the South African Depression and Anxiety Group (SADAG), less than 16% of sufferers receive treatment for mental illnesses.

How’s your mood today?

About 5% of South Africans suffer from a mood disorder such as depression, and around three in 10 people in any given workplace experience symptoms of depression at some time. Mood disorders are common forms of mental illness among South Africans.

These disorders typically involve persistent feelings of sadness or periods of feeling excessively happy, or fluctuations between these two extremes. Two of the most common mood disorders are depression and bipolar disorder.

After diabetes, depression is the second most searched topic on the internet worldwide. This gives an indication of how widespread the problem is. It can be caused by any number of factors, including genetics, upbringing, trauma, reinforcement and social learning.

We all suffer from “the blues” at some or other stage, but these feelings usually pass. However, if you feel down for long periods and find a sense of hopelessness taking over your whole life, you could be suffering from depression.

Depression is a medical condition characterised by feelings of sadness and unhappiness that have a negative impact on your everyday life. Some people with depression may not feel sad but rather hopeless or helpless, sometimes even angry.

Depression is also linked to another mental illness that is a regular feature in our daily stress-filled lives: anxiety.

Although quite different to depression, many people suffering from anxiety become depressed, while those with depression can develop anxiety. Anxiety disorders are characterised by a sense of doubt and vulnerability about the future. Symptoms include anxious thoughts, unexplained physical sensations such as heavy sweating or headaches, and avoidant or self-protective behaviours.

Both these disorders cause a feeling of hopelessness, which often leads to inaction. People with depression and anxiety feel that there is no place to turn to for relief because that’s the nature of these disorders.

Depression can be a stand-alone diagnosis, or part of another disorder such as bipolar disorder. Bipolar disorder is an illness that causes severe mood swings, from the highest of highs (mania) to the lowest of lows (depression). Sufferers often have regular episodes of the illness, which can be severely destructive to their private and professional lives.

Unlike the usual mood swings we all experience at some time, bipolar disorder is a medical condition in which people have severe mood swings that are out of proportion, or totally unrelated to what is going on in their lives. These can affect feelings, thoughts, physical health, behaviour and functioning.

Bipolar is a combination of mania and depression, alternating in cycles. Symptoms associated with mania may include inflated self-esteem, tendency to be excessively talkative, decreased need for sleep, racing thoughts and an excessive preoccupation with pleasurable activities that may have negative repercussions, such as unrestrained buying sprees or sexual indiscretions.

Bipolar disorder occurs due to a chemical imbalance in the brain. It should never be viewed as someone’s fault or evidence of an unstable personality.

Depression, anxiety and bipolar are treatable

While there is no single, simple cure or treatment for bipolar disorder, a combination of education, medication, psychological counseling and support can transform bipolars from sufferers to survivors, enabling them to live healthy, full lives.

Sufferers of depression and/or anxiety should also know that it is possible to cure these illnesses. Unfortunately both these disorders cause a feeling of hopelessness, which often leads to inaction.

If you are suffering from one of these diseases, don’t let inertia or the fear of stigma keep you trapped. Treatment can provide relief by identifying what’s wrong and reducing symptoms that interfere with your work and personal life.

Where to turn to?

South Africans on medical schemes are usually in the fortunate position of being able to turn to their medical scheme. In fact, benefits paid by medical schemes for the treatment of mental health illness are rising rapidly. According to Deepa Jaga, executive manager for disease management at Metropolitan Health Risk Management, there is a growing understanding that mental illnesses are chronic conditions—not unlike asthma, diabetes or hypertension and, similar to these chronic diseases, mental illness can be managed successfully through disease management.

As a result, many medical schemes have established disease management programmes to assist their members in proactively managing mental illness conditions.

Metropolitan Health Risk Management has established programmes for depression, bipolar disorder, post-traumatic stress disorder and substance abuse for various medical schemes and corporates.

Jaga says: “Our disease management programmes strive to improve the wellbeing of patients through improved education and awareness. Patients are enabled to manage their condition on a daily basis. We work closely with the treating healthcare practitioner(s) in achieving the best possible outcomes.”

These interventions have a measurable impact, often in the form of reduced suicide attempts and psychiatric ward admissions.

Unfortunately, general patient apathy and stigma means many patients who would benefit are reluctant to join these programmes. Jaga urges medical scheme members suffering from a mental illness to find out about their scheme’s disease management programme.

The usage of EAP services has been shown to effectively reduce depressive symptoms, particularly thoughts about suicide.

Usage of EAP services also increases the likelihood that workers will receive appropriate treatment for depression and substance abuse, and reduces the likelihood that employees will be late or absent due to alcohol abuse.

However, fear of stigma and ignorance can undermine the value EAPs deliver. Radebe encourages anyone suffering from depression, anxiety or any other mental illness to take action. Find out if your company has an employee assistance programme (EAP) and talk to the professional EAP counselors in complete confidence. Alternatively, talk to your doctor.

Support groups

There are also various support groups that can help. The South African Depression and Anxiety Group, Africa’s largest mental health support and advocacy group, offers various resources and facilitates support groups across the country. Other support organisations include Lifeline, Compassionate Friends and Reach out.

Dr Nemuhuyuni fully supports the South African National Health and Nutrition Examination Survey’s recommendation that government prioritises mental health and includes it as the fifth major NCD.

She also believes that the expertise of the better-resourced private sector should be more fully leveraged in strengthening the overall health system in order to address mental health issues.

Dr Nemuhuyuni concludes, “It’s time to embrace open conversations about mental disorders. The occurrance of mental illness is rising and incurring high social and economic costs. Soon it could even overtake HIV and Aids as the leading cause of illness in South Africa. It’s time to give mental illness the urgent attention it demands.”

This feature has been made possible by the M&G’s advertisers. Contents and pictures were sourced independently by the M&G’s supplements editorial team.